45D2306657 CLIA NUMBER - MD REQUEST PLLC DBA PURE MEDICINE

Laboratory Demographics

  • CLIA Code: 45D2306657
  • Facility Name: MD REQUEST PLLC DBA PURE MEDICINE
  • Facility Address: 4645 AVON LANE SUITE 200
    FRISCO, TX
    ZIP 75033
  • Facility Phone: 469 430-5850
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JORDAN M. PASTOREK
  • NPI Number: 1316281975
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D2306657
LAB Type Physician Office
Facility Name MD REQUEST PLLC DBA PURE MEDICINE
Street 4645 AVON LANE SUITE 200
City FRISCO
State TX
ZIP 75033
Phone 469 430-5850
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/21/2024
Certificate Expiration Date 6/20/2026
Facility Type Physician Office
Lab Director JORDAN M. PASTOREK

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This page was last updated on: 9/29/2025